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o <br />D. <br />TEMPORARY EVENT APPLICATION <br />1.Name of Event: <br />2. <br />3. <br />4. <br />5. <br />6.Average Age: <br />UTILITIES <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />APPLICATION <br />1. <br />2. <br />Date: <br />T <br />I understand that as <br />standards and the Enn <br />Submit the following to the Environmental Health Department two weeks prior to the event: <br />a) Temporary Event Application <br />b) Application Review Fee of $130 <br />c) Temporary Food Vendors Applications for each booth <br />d) Temporary Event Site Plan <br />e) Food Vendor List <br />This application is to be completed and signed by the Event Coordinator, then returned to the <br />Environmental Health Department with all Food Vendor’s Applications no later than two weeks prior to the <br />event. <br />IQ 'I <br />ZXJ Gt ‘yS <br />Date(s) of Event: <br />Location: Ofc <br />Event Coordinator (Name):. <br />Mailing Address: <br />Number of Food Booths: <br />GENERAL EVENT FILE INFORMATION <br />orccyj ( ) <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />• $130 per hour (weekdays 8:00 am to 5:00 pm) <br />• After regular business hours (weekday, weekends and holidays) the inspection is charged at the <br />hourly rate, calculated at one and one half times ($195.00 per hour) <br /> Yes El No <br /> Yes T^No <br />^LYes No <br />Is potable water supplied and available for each food vendor: <br />Is electricity supplied and available for each food vendor: <br />Are janitorial facilities available: <br />Number of toilets provided: / 3 <br />Name of sanitary garbage disposal company: <br />Method of disposal of liquid waste for food booths: <br />temporary event coordinator, I am responsible for meeting California State <br />nmental Health. Departmejit policies and procedures. <br />______Time of Event: / (9' ~ <br />__Telephone: j.Ba <br />OAN UUAUUIN CUUN I Y <br />|_.<VIRONMENTAL HEALTH DEPAR. wlENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 Ij <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />eNI/°°r<,Sa”5 <br />■ • W ■ ■ MM W MM M W M M ■ M M 1MM -M- M M M M M J Ftf^lIj,' Q <br />To be completed and signed by Event Coordinator, then returned to the Environmental Health Department' wtn^ffFg <br />of the Food Vendor’s Applications no later than two weeks prior to event <br />(Oc Jr-Ao-e J C) <br />I VK <br />)v H TV <br />A3 <br />Approximate attendance at peak time: / <br /> Number of dumpsters: <br />'C. g <br />O rJ <br />. Total Attendance: /, SOS <br />Event Coordinafocr